Key result
Social Security scheme linked to ~81% higher in-hospital MACE after PCI versus Government Service.
Why the study?
Limited literature provides minimal information on clinical outcomes among patients undergoing PCI under different healthcare funding systems, especially in Thailand.
Does the type of healthcare funding scheme affect in-hospital clinical outcomes in patients undergoing PCI?
Observational (n=22,741)
Yes
Does the type of healthcare funding scheme affect in-hospital clinical outcomes in patients undergoing PCI?
Effect estimate: OR 1.22 for UC vs GS, OR 1.81 for SS vs GS (95% CI UC: 1.04 to 1.44; SS: 1.38 to 2.37)
Absolute Event Rate: 13.8% vs 10.1%
p-value: p=0.017 for UC vs GS; <0.001 for SS vs GS
Healthcare funding policies in Thailand are significantly associated with disparities in in-hospital outcomes for patients undergoing PCI, with the Government Service scheme demonstrating better clinical outcomes despite higher baseline risk.
Background The limited literature provides minimal information on clinical outcomes among patients undergoing percutaneous coronary intervention (PCI) under different healthcare funding systems, especially in Thailand. Objective The study aimed to investigate the association between in-hospital clinical outcomes of patients treated with PCI and different types of healthcare funding in Thailand. Method The Thai PCI registry is a multicentre, prospective national registry with 39 participating medical centres. Web-based data entry, collected between May 2018 and August 2020, was centrally managed and analysed, providing clinical characteristics, medical management and in-hospital outcomes. Results A total of 22 741 patients were analysed and classified into four groups: the Universal Health Coverage Scheme (UC) (63.1%), Government Service Scheme (GS) (26.8%), Social Security Service Scheme (SS) (6.8%) and other payment fund (3.2%). The SS group was younger and predominantly male, whereas cardiovascular risk factors were higher in the GS group. After adjusting for baseline characteristics and management strategies, in-hospital MACE outcomes of ACS patients were significantly higher in patients in the SS (OR=1.81 (1.38, 2.37), p<0.001) and UC group (OR=1.22 (1.04, 1.44), p=0.017) compared with the GS group. Post-procedural myocardial infarction was also higher across all groups. Though differences in all-cause death and cerebrovascular accident/stroke were not statistically significant. Conclusion Healthcare funding policies in Thailand significantly associated with disparities in-hospital outcomes of patients undergoing PCI. Patients receiving treatment under the GS scheme demonstrated better clinical outcomes compared to other schemes. These findings highlight the need for policy adjustments aimed at reducing healthcare disparities to improve patient outcomes.
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Hongsakul et al. (2026) conducted an observational in patients undergoing percutaneous coronary intervention (PCI) for coronary artery disease (n=22,741). Percutaneous coronary intervention (PCI) under different healthcare financing schemes (Universal Coverage (UC), Government Service (GS), Social Security Service (SS), Other Funds (OF)) vs. Government Service (GS) scheme was evaluated on composite of in-hospital all-cause mortality, post-procedural myocardial infarction (MI), and cerebrovascular accident (CVA)/stroke (OR 1.22 for UC vs GS, OR 1.81 for SS vs GS, 95% CI UC: 1.04 to 1.44; SS: 1.38 to 2.37, p=0.017 for UC vs GS; <0.001 for SS vs GS). Patients undergoing PCI under the Social Security Service scheme had 81% higher odds and those under the Universal Coverage scheme had 22% higher odds of in-hospital MACE compared to the Government Service scheme in Thailand.
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